| NPI | 1891040440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0105X Surgery, Surgery of the Hand (Licence: AZ 58871) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH AO5603724206896) |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2019-10-18 |